Perowne’s Decision: Causality and Consequences

Put yourself in Henry Perowne’s shoes.

Your beloved car is hit by a man who failed to look before pulling out. This man is legally at fault for the accident, but argues to the contrary. He attempts to extort $750.00 from you as recompense for damages. When you refuse to pay up, he settles for a good old-fashioned beating, leaving you with a nasty bruise on the sternum.

Fast-forward a bit. It’s later in the same day; everything is back on track, back to normal. Your family is coming over for dinner; you’re looking forward to the reunion, the meal, and the prospect of reconciliation between your daughter and father-in-law.

Already, the day’s earlier trial has begun to fade from your mind. A scratch on your Mercedes, a painful but temporary bruise – these minor inconveniences seem to be the worst that’s come of it. Entirely manageable, hardly worth dwelling on. Soon, it seems, the accident, the encounter, the man himself, will be nothing more than a bad memory – maybe even an entertaining story to share at your next squash game.

But he isn’t finished with you yet. He’s only begun to wreak havoc.

He stalks you; he seizes your wife’s return as an opportunity to forcibly enter your home. Allow me to emphasize this point: he invades your private residence – your place of solace, of respite, the place where your children were raised – with a knife, an unsound mind, and cruel intentions.

This man holds your family hostage. He breaks your father-in-law’s nose with a vicious strike. He holds a knife to the throat of your wife, threatening to kill her. He forces your daughter to strip, and nearly takes this sexual abuse further. In the end, with the help of your son, you bring this nightmare to an end by throwing the man down a flight of stairs.

In all likelihood, you and your family will never forget this terrible ordeal, this act of extreme violence. This man is almost certainly the worst thing that’s ever happened to you and your family.

Now, suddenly, you’re on the phone, being asked to come in to perform lifesaving surgery on this very same man. What do you do?

If you’re Henry Perowne, you say yes, and you save Baxter’s life.

In his place, I would not do the same. To me, it’s not even a hard decision. He tormented Perowne’s family, physically and psychologically. Guilt or remorse for his condition never even comes into question. While I might not wish death upon him, I would refuse to be the one to save him.

Besides, refusing the surgery is not tantamount to a death sentence – there are other neurosurgeons capable of performing the operation. Perowne would not be pulling the trigger by declining.

Furthermore, Perowne is at great personal risk by accepting the operation. Given the circumstances, if the surgery should fail, Perowne will almost certainly have his medical license revoked. Even a success, leaves a bad taste in the mouth, a lingering doubt as to whether this was the ethically or professionally right. In my opinion, Perowne’s connection to Baxter makes it impossible for him to rightfully accept the job, regardless of the outcome.

I have to wonder: if it takes no deliberation on my part to come to this conclusion, then what makes it just as simple for Perowne to settle on the exact opposite?

To consider it from a simple angle, perhaps Perowne’s decision is a function of his professional confidence. He is a superb neurosurgeon, and he knows it. So, while there are potential substitutes, in his confidence – perhaps arrogance – Perowne concludes that he is the best, and is thus obligated to rise to this challenge. Simple professionalism: that’s one possible answer. Perowne is a neurosurgeon, and this man is in need of neurosurgery. Personal circumstances are not allowed to interfere with his profession.

A consummate professional.

Simple professionalism: that’s one possible explanation. It’s not, however, the one I subscribe to. In fact, I think the truth is just the opposite: human emotion, rather than cold professionalism, is the key factor. In my mind, Perowne makes his decision based on guilt.

Certainly, I don’t mean Perowne feels guilty for injuring Baxter. Rather, Perowne feels uneasy about the stark differences between Baxter’s life and his own. Perowne admits to having had every advantage growing up, and now has what many would consider an ideal life. Baxter never had such opportunities (or so Perowne imagines). His social circumstances presented him with a more difficult road through life. As if this weren’t enough, a bad roll of the genetic dice has condemned Baxter to suffer from Huntington’s, a terrible, progressive neurodegenerative disease for which there is no cure.

This is bothersome to Perowne. He cannot comprehend why things should be this way – why he should be blessed with everything, while Baxter struggles through life.

In Perowne's mind, the scales do not tip evenly for himself and Baxter.

This ultimately leaves Perowne with a feeling of guilt. He did not ordain for things to be this way; he is not to blame for Baxter’s disease. Still, he finds no justice, no reason for such a disparity. He cannot reconcile the differences between himself and Baxter. As such, he feels compelled to do what he can for the man, unfairly saddled with such a difficult existence.

I still feel this is not enough. To me, accepting the surgery remains a mistake, on a personal, ethical, and professional basis. But it’s not up to me, and it’s done. If I accept this, the question in my mind becomes where things go from here. What will be the consequences of this decision? Will Perowne have to answer for his dubiously ethical decision, or will he be hailed as a saint? Will Baxter be grateful to Perowne, or will he be furious that Perowne has, in a way, further embarrassed him? Is it possible that Perowne will feel he has atoned for the sin of having a better life, or will he continue his efforts to help Baxter?

Perowne himself might have some idea of the answers, or he could be as much in the dark as I am. Perhaps he approaches the operation as he does the war: the outcome cannot be known for certain, but maybe it won’t be regretted down the road, and that is justification enough for him.